First Name*

Last Name*

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

What animal are you interested in?
Choose an animal: Asparagus(Gus) Avalon Blair Brownie Choppo Delicata Fiona Franklie Greta Hazel Jasper Mason Mysti Riley Sabrina Shug Siri Squash Toby Tomato(Mater) Tucker Turnip Whiskey Willy

What animal are you interested in? (second choice)
Choose an animal: Asparagus(Gus) Avalon Blair Brownie Choppo Delicata Fiona Franklie Greta Hazel Jasper Mason Mysti Riley Sabrina Shug Siri Squash Toby Tomato(Mater) Tucker Turnip Whiskey Willy

Which animal are you interested in? (third choice)
Choose an animal: Asparagus(Gus) Avalon Blair Brownie Choppo Delicata Fiona Franklie Greta Hazel Jasper Mason Mysti Riley Sabrina Shug Siri Squash Toby Tomato(Mater) Tucker Turnip Whiskey Willy

The animal I am interested in is not listed, I am applying for:

Please list your full address including city, state, and zip code*

Do you own or rent your home?*
Choose one: Own Rent

How long have you been living at your current residence

Please list the last two places you lived and how long you lived there:

If you rent, what is your landlords name and phone number?

What is your date of birth?*

How many adults live in your home?*

What are the full names (First Middle Last & Maiden name) and birthdates for anyone over 18 years of age who lives in the home?*

How many children live in the home and what are their ages?*

Are you employed? If so, what is the name(s) of your employer? *

Animal Care

Are there any other animals in your home? If so please list the type, age, and sex of the animal.*

Are all of your animals altered (neutered/spayed)?*
Choose one: Yes No

If no, please explain.

Are there any animals that you have owned that you no longer have?*
Choose one: Yes No

If yes, please explain.

Please provide us with the name and phone number for a Vet reference.*

How many hours a day will the dog be home alone?*

When the dog is left alone, where will it be? Check all that apply:

The dog will live (mark all that apply):

What type of housing do you live in?*
Choose one: Single family home Apartment Condo Mobile home

How big is your yard?*
Choose one: Small Medium Large Acreage No yard

Do you have a fenced in yard?*
Choose one: Yes No

If yes, please describe height and type of fence (e.g., wood, chain link, etc.).

Please tell us about your lifestyle so that we can find the best fit for your home. (I.e., very active, quiet and stay home, travel a lot, outdoors a lot, etc.)*

How will you exercise the dog? Check all that apply:

If other, please explain

Besides your vet reference, please give us the name and telephone number for two other references that are not related to you that can attest to your character:*

Please answer the following questions in depth.

What experience do you have with dogs? If you are looking to adopt a dog we have listed as a specific breed, mix, or type (e.g., hound, terrier, Great Dane, Pit Bull, etc.) please also provide information about your specific experience with that breed/type. Please also include any research you have done on your own and what you have learned*

It is important that all precautions are taken to ensure that your dog is never running around at large for many reasons. Can you ensure that the dog you apply for will always be supervised when outside? He or she may be able to easily break a chain or get out of a fence if not supervised. Please share your thoughts.*

Dogs want to please their owners and learn best through positive reinforcement. When training, you will get better results through consistency and rewarding good behavior rather than punishing unwanted behavior. Please tell us about your experience with and approach to training. Please also include any research you have done on your own and what you have learned.*

Please tell us about the characteristics and personality you are looking for in a dog. How do the dog(s) you have expressed interest in match with your lifestyle? *

Many things can change in life. How can you ensure that the dog you are applying for will be taken care of through all stages of life?**

Some dogs can have high dog aggression and should not be taken off leash or taken to dog parks because of this. We encourage dog socialization and play dates in a controlled environment with slow introductions. Please tell us about your approach to introducing your dog to other animals.*

How long are you willing to give the dog to adjust to being a member of your family? How are you going to help the dog with this adjustment?*

Why would you be a good home for one of our dogs?*

IMPORTANT NOTE!!

Many homeowner's insurance companies have breed blacklists which include but are not limited to, pit bulls, American Pit Bull Terriers, American Staffordshire Bull Terriers, Rottweilers, Dobermans, Akitas, American Bulldogs, Chows, wolf-hybrids, and mixes of these types of dogs. If the insurance company has a breed blacklist, they will not insure you if the animal resides in your home or may cancel your insurance if you add a dog of these breeds to your home.  Please check your homeowner's insurance policy regarding breed discrimination BEFORE adopting/fostering a pit bull type dog. Landlords may also have these same breed restrictions due to their insurance policies.  

Please read this information carefully before signing.

Cedar Valley Pit Bull Rescue is a volunteer based, nonprofit organization that works hard to place the right dogs with the right families. We want our dogs to have great, forever homes. We do run background checks on all adults in the home and reserve the right to deny any application. We also set up a home check, once the application has been processed.

Each of our available dogs stays with a foster family while waiting to be adopted. This ensures that the dogs stay socialized and remain in a family setting. Even with foster homes it can still take some time for the dogs to settle into their new surroundings when they are adopted. In the first few days, you may see some signs of stress from the dog. This can be very normal. We ask that you give the dog two weeks to fee comfortable and adapt in your home. You may contact us at any time if you have any questions or concerns. We will gladly help. Once you have adopted the dog, if for any reason you cannot keep the dog, you must bring it back to Cedar Valley Pit Bull Rescue. Our adoption fees are based on the dog's vet bills and are considered a nonrefundable donation. 

By signing you are agreeing to the above information and understand that filling out the application is not an automatic approval. We work very hard to make sure our dogs are placed in the right forever homes. We reserve the right to deny any application. We will contact you once your application has been reviewed. This typically takes 24-48 hours but can occasionally take longer.

Name and Date By typing your name in the box below you are providing an electronic signature that you have read through the information provided in this application and you have provided truthful responses to all questions. By submitting this application, you are consenting to have a background check conducted on you and all other adult members of your household. *